The Utility of Virtual Patient Simulations for Clinical Reasoning Education

Abstract

Virtual Patient Simulations (VPSs) have been cited as a novel learning strategy, but there is little evidence that VPSs yield improvements in clinical reasoning skills and medical knowledge. This study aimed to clarify the effectiveness of VPSs for improving clinical reasoning skills among medical students, and to compare improvements in knowledge or clinical reasoning skills relevant to specific clinical scenarios. We enrolled 210 fourth-year medical students in March 2017 and March 2018 to participate in a real-time pre-post experimental design conducted in a large lecture hall by using a clicker. A VPS program (®Body Interact, Portugal) was implemented for one two-hour class session using the same methodology during both years. A pre–post 20-item multiple-choice questionnaire (10 knowledge and 10 clinical reasoning items) was used to evaluate learning outcomes. A total of 169 students completed the program. Participants showed significant increases in average total post-test scores, both on knowledge items (pre-test: median = 5, mean = 4.78, 95% CI (4.55–5.01); post-test: median = 5, mean = 5.12, 95% CI (4.90–5.43); p-value = 0.003) and clinical reasoning items (pre-test: median = 5, mean = 5.3 95%, CI (4.98–5.58); post-test: median = 8, mean = 7.81, 95% CI (7.57–8.05); p-value < 0.001). Thus, VPS programs could help medical students improve their clinical decision-making skills without lecturer supervision.

Virtual Simulation for Last-Year Nursing Graduate Students in Times of Covid-19: A Quasi-Experimental Study

“… Gu et al (2017) reported similar results regarding knowledge evaluation (experimental group=73.31±9.27 vs control group=65.36±8.93; p=0.032). Other studies carried out with different VS platforms in the health field describe equally positive results ( Watari et al, 2020 ; Borg-Sapiano et al, 2018 ).…”

Virtual, Augmented, and Alternate Reality in Medical Education: Socially Distanced but Fully Immersed

“…Compared with standard screen-based learning, fully immersive virtual environments have demonstrated significantly higher knowledge retention ( 15 , 17 ). VR also has utility in portraying complex clinical scenarios in problem-based learning formats, allowing for flexibility in training across geographically diverse locations ( 18 , 19 ).…”

Clinical reasoning during the COVID-19 pandemic

“…The care providers must be informed about the nature and process of decision-making in a disaster; the situation must be managed mainly according to “code-of-practice” not personal judgment in most cases. On the other hand, guideline developers must be vigil and watchful for ever-changing best available evidence as they process these data continuously to form the most consistent cost-efficient nonharmful recommendations and avoid bursts of scientific impulse-induced uncontrolled emotional decisions To avoid cognitive errors, the pressure on the clinical community (including trainees) should be diminished during times of uncertainty[ 6 7 ] by a decrement of workload, considering time constraints, improving clinical reasoning skills using virtual methods,[ 8 9 10 11 12 ] and encouraging teamwork. It is reasonable that one person alone does not decide in complex cases like severe intensive care patients with multi-organ complications.…”

“…To avoid cognitive errors, the pressure on the clinical community (including trainees) should be diminished during times of uncertainty[ 6 7 ] by a decrement of workload, considering time constraints, improving clinical reasoning skills using virtual methods,[ 8 9 10 11 12 ] and encouraging teamwork. It is reasonable that one person alone does not decide in complex cases like severe intensive care patients with multi-organ complications.…”